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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1041-1046. doi: 10.19723/j.issn.1671-167X.2024.06.015

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COVID-19 vaccines efficacy and infection features in patients with systemic sclerosis: A single-center cohort study

Wei PAN1,2, Yun LI1, Junjia LUO3, Chun LI1, Hua YE1, Xue LI1,*(), Yuan JIA1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People' s Hospital, Beijing 100044, China
    2. Department of Clinical Laboratory, 923 Hospital of the Chinese People' s Liberation Army Joint Logistic Support Force, Nanning 530021, China
    3. Department of Rheumatism and Immunology, Longhua District People' s Hospital, Shenzhen 518110, Guangdong, China
  • Received:2024-08-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Xue LI, Yuan JIA E-mail:lx_bjmu@aliyun.com;jiayuan1023@sina.com
  • Supported by:
    National Natural Science Foundation of China(81871281);Peking University People's Hospital Scientific Research Development Funds(RDX2022-02)

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Abstract:

Objective: To comprehensively understand the COVID-19 vaccination and infection status among patients with systemic sclerosis (SSc). Methods: We conducted a retrospective analysis of patients diagnosed with SSc who were hospitalized in the Rheumatology and Immunology Department of Peking University People' s Hospital from January 2016 to March 2023. We collected detailed clinical cha-racteristics, vaccination status, and infection details through a systematic review of medical records and telephone follow-ups with the SSc patients. Results: Out of 236 identified patients, 99 SSc patients participated in the follow-up. This cohort included 41 patients with limited SSc, 28 with diffuse SSc, and 30 with SSc overlap syndromes. Treatments varied, with glucocorticoids administered to 57.58% of patients, immunosuppressants to 56.57%, biologic agents to 7.07%, and small molecule targeted therapies to 6.06%. Notably, 49 patients had received the COVID-19 vaccine. Between November 2022 and March 2023, a total of 81 patients contracted COVID-19. The infection rate among those who received three doses or more (19/29, 65.5%) was significantly lower compared with unvaccinated patients (45/50, 90.0%, P=0.007). Fourteen of these patients required hospitalization due to COVID-19. Furthermore, 26 patients reported exacerbation of SSc symptoms post-infection, which included severe manifestations, such as Raynaud phenomenon, skin lesions, fingertip ulcers, pulmonary hypertension, and interstitial lung disease. Compared with healthy cohabitants, the SSc patients exhibited more severe symptoms following COVID-19, including fever (36.71%) and fatigue (35.44%). Multivariate regression analysis identified subcutaneous calcinosis (OR=7.713, 95%CI: 1.142-45.051) and positivity for anti-centromere antibodies (OR=9.210, 95%CI: 1.211-70.028) as independent risk factors for hospitalization due to COVID-19. Conclusion: Vaccination is both effective and safe in preventing COVID-19 among SSc patients. Additionally, it underscores that these patients experience exacerbation of their underlying disease and more severe COVID-19 symptoms compared with individuals without underlying conditions. Thus, proactive prevention, continuous monitoring, and early treatment of COVID-19 are of significant importance for the health and well-being of SSc patients. Timely interventions can help mitigate the impact of infections and improve overall patient outcomes.

Key words: Systemic sclerosis, COVID-19, COVID-19 vaccines

CLC Number: 

  • R593.2

Table 1

General information of patients with systemic sclerosis (n=99)"

Items Data Items Data
Age/years, $\bar x \pm s$ 54.92±14.30 Results of laboratory tests, n (%)
Female, n (%) 93 (93.94)   ANA+ 64 (64.65)
BMI/(kg/m2), $\bar x \pm s$ 22.54±4.02   Anti-Scl-70+ 25 (25.25)
Localized SSc, n(%) 41 (41.41)   ACA+ 10 (10.10)
Diffuse SSc, n (%) 28 (28.28)   Anti Ro-52+ 18 (18.18)
Overlap syndrome, n (%) 30 (30.30)   Anti-ku+ 4 (4.04)
  RA 8 (8.08)   Anti-RP11+ 2 (2.02)
  SLE 9 (9.09)   Anti-RP155+ 2 (2.02)
  Other 13 (13.13)   Anti PM-Scl100+ 1 (1.01)
Clinical manifestations, n (%)   Anti-Th/To+ 2 (2.02)
  Raynaud phenomenon 85 (85.85) Use medication before infection, n (%)
  Arthritis 26 (26.26)   Glucocorticoid 57 (57.58)
  Myositis 7 (7.07)   Hydroxychloroquine 34 (34.34)
  Subcutaneous calcareous deposition 8 (8.08)   Immunosuppressants 56 (56.57)
  Digestive tract involvement 23 (23.23)   Tocilizumab 6 (6.06)
  Heart involvement 11 (11.11)   JAK inhibitors 6 (6.06)
  Interstitial lung disease 50 (50.51)   Rituximab 1 (1.01)
  Kidney crisis 4 (4.04)

Table 2

COVID-19 vaccination status in patients with systemic sclerosis (n=99)"

Items n(%)
Number of COVID-19 vaccine recipients 49 (49.50)
  One dose 7 (14.29)
  Two doses 13 (26.53)
  Three doses 28 (57.14)
  Four doses 1 (2.04)
Developed symptoms after vaccination
  Muscle soreness 10 (20.41)
  Injection site inflamed and swollen ≥3 d 4 (8.16)
  Fatigue 4 (8.16)
  Joint pain 3 (6.12)
  Nausea and vomiting 2 (4.08)
  Fever 1 (2.04)
  Dyspnea or hospitalization 0

Figure 1

Incidence of coronavirus infections in patients with systemic sclerosis stratified by COVID-19 vaccination dosage"

Table 3

COVID-19 status and treatment in patients with systemic sclerosis (n=81)"

Items Data
Diagnostic methods, n(%)
  COVID-19 antigens positive 48 (59.26)
  COVID-19 nucleic acid positive 12 (14.81)
  Developed similar symptoms following exposure 18 (22.22)
No symptoms, n(%) 3 (3.70)
Duration of symptoms/d, $\bar x \pm s$ 25.53±24.62
Therapy, n(%)
  Chinese traditional medicine 30 (37.04)
  Antipyretic analgesics 21 (25.93)
  Glucocorticoid 19 (23.46)
  Nirmatrelvir 2 (2.47)
  Other antivirals (interferon alpha, oseltamivir) 3 (3.70)
Measures taken during infection, n(%)
  Oxygen 5 (6.17)
  Inpatient care 14 (17.28)

Figure 2

Performance of systemic sclerosis patients compared to cohabitants"

Table 4

Changes in patients with systemic sclerosis during coronavirus infection"

Items n(%)
Patients feeling worsened 26 (32.10)
New or exacerbated manifestations
  Raynaud phenomenon 22 (27.16)
  Skin swelling and hardening 16 (19.75)
  Skin ulcers 8 (9.88)
  Heart involvement 3 (3.70)
  Pulmonary hypertension 3 (3.70)
  Interstitial lung disease 15 (18.52)

Table 5

Comparison of baseline characteristics between hospitalized and non-hospitalized groups in systemic sclerosis patients with COVID-19"

Clinical data Hospitalized treatment (n=14) Non-hospitalized treatment (n=67) t/χ2 P
Age/years, $\bar x \pm s$ 58.57±11.17 52.67±14.75 -1.312 0.189
Female, n (%) 14(100.00) 62(92.54) 1.100 0.294
BMI/(kg/m2), $\bar x \pm s$ 21.79±3.64 23.06±5.27 -0.631 0.528
Localized SSc, n(%) 6(42.86) 30(44.78) 0.017 0.895
Diffuse SSc, n (%) 2(14.29) 17(25.37) 0.867 0.352
Overlap syndrome, n (%) 4(28.57) 20(29.85) 0.009 0.924
  RA 1(7.14) 7(10.45) 0.153 0.696
  SLE 1(7.14) 8(11.94) 0.298 0.585
  Other 3(21.43) 7(10.44) 1.125 0.287
Clinical manifestations
  Raynaud phenomenon 14(100.00) 55(82.09) 4.972 0.026
  Arthritis 3(21.43) 17(25.37) 0.099 0.753
  Myositis 1(7.14) 5(7.46) 0.002 0.967
  Subcutaneous calcareous deposition 4(28.57) 4(5.97) 5.168 0.023
  Digestive tract involvement 7(50.00) 14(20.90) 2.741 0.193
  Heart involvement 4(28.57) 5(7.46) 4.189 0.041
  Interstitial lung disease 8(57.14) 35(52.24) 0.112 0.738
  Kidney crisis 1(7.14) 2(2.99) 0.554 0.457
Results of laboratory tests
  ANA+ 12(85.71) 49(73.13) 1.085 0.298
  Anti-Scl-70+ 4(28.57) 21(31.34) 0.009 0.837
  ACA+ 4(28.57) 3(4.48) 6.405 0.011
  Anti Ro-52+ 3(21.43) 12(17.91) 0.095 0.758
  Anti-ku+ 0 3(4.48) 0.651 0.420
  Anti-RP11+ 1(7.14) 1(1.49) 1.535 0.215
  Anti-RP155+ 1(7.14) 1(1.49) 1.535 0.215
  Anti PM-Scl100+ 0 1(1.49) 0.212 0.646
  Anti-Th/To+ 0 2(2.99) 0.428 0.513
Use medication before infection
  Glucocorticoid 6(42.86) 40(59.70) 1.339 0.247
  Hydroxychloroquine 8(57.14) 22(32.84) 2.934 0.087
  Immunosuppressants 10(71.43) 37(55.22) 1.249 0.264
  Tocilizumab 0 5 (7.46) 1.233 0.294
  JAK inhibitors 1(7.14) 3 (4.48) 0.173 0.677
  Rituximab 0 1 (1.49) 0.209 0.648
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